title: A retrospective study on patient characteristics and telehealth alerts indicative of key medical events for heart failure patients at a home health agency.
abstract: OBJECTIVE
  To explore association of patient characteristics and telehealth alert data with all-cause key medical events (KMEs) of emergency department (ED) visits and hospitalizations as well as cardiac-related KMEs of ED visits, hospitalizations, and medication changes.
  
  
  METHODS
  A 6-month retrospective study was conducted of electronic patient records of heart failure (HF) patients using telehealth services at a Massachusetts home health agency. Data collected included patient demographic, psychosocial, disease severity factors and telehealth vital signs alerts. Association between patient characteristics and KMEs was analyzed by Generalized Estimating Equations.
  
  
  RESULTS
  The sample comprised 168 patients with a mean age of 83 years, 56% females, and 96% white. Ninety-nine cardiac-related KMEs and 87 all-cause KMEs were recorded for the subjects. Odds of a cardiac-related KME increased by 161% with the presence of valvular co-morbidity (p=0.001) and 106% with increased number of telehealth alerts (adjusted p<0.0001). Odds of an all-cause KME increased by 124% (p=0.02), 127% (p=0.01), and 70% (adjusted p<0.0001) with the presence of cancer co-morbidity, anxiety, and increased number of telehealth alerts, respectively. Overall, only 3% of all telehealth alerts were associated with KMEs.
  
  
  CONCLUSIONS
  The very low proportion of telehealth vital sign alerts associated with KMEs indicates that telehealth alerts alone cannot inform the need for intervention within the larger context of HF care delivery in the homecare setting. Patient-relevant data such as psychosocial and symptom status, involvement with HF self-management, and presence of co-morbidities could further inform the need for interventions for HF patients in the homecare setting.
authors.affiliation: 1 School of Nursing, University of Texas at Austin , Austin, Texas.
authors.forename: Kavita
authors.initials: K
authors.lastname: Radhakrishnan
authors.forename: Kathryn
authors.initials: K
authors.lastname: Bowles
authors.forename: Alexandra
authors.initials: A
authors.lastname: Hanlon
authors.forename: Maxim
authors.initials: M
authors.lastname: Topaz
authors.forename: Jesse
authors.initials: J
authors.lastname: Chittams
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D056902:Clinical Alarms; D015897:Comorbidity; D003422:Critical Care; D057286:Electronic Health Records; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000523:psychology; D018574:Home Care Agencies; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008404:Massachusetts; D008485:Medical Audit; D012189:Retrospective Studies; D017216:Telemedicine